Volume 2 No.

1 2025, 135 - 148

DOI : 10.62335

Jurnal Penelitian dan Pengkajian Ilmiah

https://manggalajournal.org/index.php/cendekia
E-ISSN 3031-8939

Bridging Communication Gaps in Healthcare: An Applied Linguistics Perspective on

Patient-Practitioner Interactions

Nara Saria*, Zusana E. Pudyastutib

a
Universitas PGRI Kanjuruhan Malang
b
Sekolah Tinggi Informatika & Komputer Indonesia
email: [email protected]*

INFO ARTIKEL ABSTRACT

Riwayat Artikel: Effective communication is crucial in healthcare for ensuring patient
Received : 18 Desember 2024 safety, improving outcomes, and enhancing satisfaction. This study
Revised : 17 Januari 2025 examined healthcare communication through the lens of applied
Accepted : 22 Januari 2025 linguistics, focusing on themes outlined by Candlin and Candlin (2003),
including interpreters, narratives, risk, patient-practitioner interactions,
Keywords: and critical accounts. Interviews with seven healthcare practitioners in
Healthcare Communication, Indonesia and Finland reveal challenges such as language diversity and
Applied Linguistics, limited access to interpreter services, leading to reliance on informal
Healthcare Practitioners, strategies like gestures and family involvement. The findings highlight the
Patient Satisfaction importance of cultural competence in bridging communication gaps,
emphasizing its role in addressing patient needs and fostering trust.
Kata Kunci: Additionally, the study underscores the potential of therapeutic
Komunikasi Kesehatan, communication training and technology-driven solutions, such as
Linguistik Terapan, Praktisi
telehealth interpreting services, to enhance healthcare interactions. By
Kesehatan, Kepuasan Pasien
integrating linguistic insights, the research advocates for collaborative,
DOI: 10.62335 multidisciplinary efforts to improve communication practices in diverse
healthcare settings. Future studies should explore cultural competence
training and innovative technological approaches to address language-
related challenges in healthcare.

ABSTRAK
Komunikasi yang efektif sangat penting dalam perawatan kesehatan
untuk memastikan keselamatan pasien, meningkatkan hasil, dan
meningkatkan kepuasan. Studi ini meneliti komunikasi perawatan
kesehatan melalui sudut pandang linguistik terapan, dengan fokus pada
tema-tema yang diuraikan oleh Candlin dan Candlin (2003), termasuk
penerjemah, narasi, risiko, interaksi pasien-praktisi, dan catatan kritis.
Wawancara dengan tujuh praktisi perawatan kesehatan di Indonesia
dan Finlandia mengungkap tantangan seperti keragaman bahasa dan
akses terbatas ke layanan penerjemah, yang mengarah pada

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ketergantungan pada strategi informal seperti gerakan dan keterlibatan

keluarga. Temuan tersebut menyoroti pentingnya kompetensi budaya
dalam menjembatani kesenjangan komunikasi, menekankan perannya
dalam memenuhi kebutuhan pasien dan menumbuhkan kepercayaan.
Selain itu, studi ini menggarisbawahi potensi pelatihan komunikasi
terapeutik dan solusi berbasis teknologi, seperti layanan penerjemahan
telehealth, untuk meningkatkan interaksi perawatan kesehatan. Dengan
mengintegrasikan wawasan linguistik, penelitian ini menganjurkan
upaya kolaboratif dan multidisiplin untuk meningkatkan praktik
komunikasi dalam berbagai pengaturan perawatan kesehatan. Studi
masa depan harus mengeksplorasi pelatihan kompetensi budaya dan
pendekatan teknologi inovatif untuk mengatasi tantangan terkait bahasa
dalam perawatan kesehatan.

INTRODUCTION
Effective communication skills are the key regardless of the context in which communication occurs.
In human-to-human communication, problems are inevitable. Therefore, applied linguistics exists to
solve real-world problems. Various issues have been discussed in applied linguistics. Take for
example in Teaching English as a Foreign Language (Raudszus, 2021), linguistic information was
applied to examine how children interpret sentences containing shared lexical and morphological
elements. In addition to that, applied linguistics has also been used in law which is called Forensic
Linguistics which investigates data collected in a (crime) case (e.g. Fraser, 2023). Other fields of
applied linguists’ interests might include internet and computer technology and even Artificial
Intelligence (AI) (e.g. Alaqlobi, et al., 2014), aviation (e.g. Jonk, et al., 2022), and politics (e.g.
Taubaldiyev, et al. 2024).
Not to exclude in health and social care, effective communication skills are important since they help
professionals in the field build and develop relationships with vulnerable people who need assistance
to feel safe, secure, and protected. This communication can be in the form of doctor-patient
communication, nurse-patient communication, and midwife-patient communication. Typical
problems related to language may arise when it comes to communication. Healthcare practitioners,
such as doctors, midwives, and nurses as professionals in their field who use language find it
problematic when for example, providing immediate verbal feedback (Horber, 2014) or
acknowledging suffering or death (Khudeir, 2017). Therefore, the health care practitioners may
consider finding an applied linguist to work collaboratively on these problems. Since applied
linguistics is believed to be able to provide solutions to real-world problems in which language is a
central issue, applying linguistics-based investigation may be taken into account.
An attempt to use applied linguistics-based study to help healthcare practitioners solve their
problems has been made by Candlin and Candlin (2003). In a book chapter entitled, “Health Care
Communication: A Problematic Site for Applied Linguistics Research”, they tried to help not only
doctors, nurses, and midwives but applied linguists, in particular, to decide on how to conduct an
applied linguistic study on this area. Despite the significance of findings discussed in the chapter,

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some important issues might be missing, such as the information provided which is related to the
site and themes in applied linguistics-based research.
In their article, Candlin and Candlin (2003) show that healthcare communication has been a growing
interest among many applied linguists. They provide many examples of journals that address these
issues and explore more of them, including the Journal of Medical Communication, Journal of Medical
Education, Journal of Advanced Nursing, and many others. While mentioning the journals, the
authors also describe their significance for applied linguistic readers.
Candlin and Candlin (2003) also mention the use of interpreters as a medical education theme which
is also engaged with the intercultural context which is particularly related to nursing. They note that
the use of interpreters is not the most addressed theme in the sociology of health care, but illness
narratives are. The illness narrative probably refers to the story that the author of the research article
tells about patients’ experiences of pain and illness. Presumably, it also describes symptoms of a
specific sickness or treatments for specific health complaints.
Additionally, risk also constitutes a theme often discussed in medical education. However, themes
such as risk remain insufficiently reflective of cultural differences and variations in understanding,
notwithstanding their potential for applied linguistic engagement on this and other grounds. In
addition to that, the practitioner-patient interaction in the doctor-patient clinical setting seems to be
much more appealing to applied linguists and discourse analysts. Studies conducted may observe
doctor’s professional communication strategies, including inviting, allowing, or discouraging
patients. Another theme is critical accounts, questioning whether the ‘therapeutic relationship’
embodies some equally entered into “contract” by practitioner and patient.
Another topic the authors discuss is the research site, which is nursing since nurses best represent
health service delivery. Nursing is an ongoing activity. Nurses are always available 24/7; therefore,
it is more likely for them to have more communication with the patients. Numerous studies with a
communication focus have been conducted at nursing sites by nursing professionals and published
in professional nursing journals, but these are typically not referenced in applied linguistic and
discourse analytic studies. Applied linguistics research in nursing will provide help for overcoming
barriers of language and associated lack of knowledge of patients’ cultures which prevent them from
getting better health care services.
What has been discussed in the entire chapter is the researchers’ position in the healthcare
profession (whether from a sociological or a linguistic orientation). It is better to have healthcare
professionals, researchers from a sociological perspective, and applied linguists or discourse analysts
work together on the research so that the results will be more significant. In terms of practical
relevance, applied linguists may not only use the health care data to refine the theory but code it
conceptually and report the results in an understandable language to the readers. They should
address the question of why and to what purpose instead of asking how. So, applied linguistics
research in health care communication should be more outcome-focused and collaboratively carried
out by professional practitioners.
Effective communication in healthcare is critical for ensuring patient safety, improving treatment

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outcomes, and enhancing overall patient satisfaction. The consequences of ineffective

communication between nurse and patient can lead to misunderstandings, misdiagnoses, and
ultimately compromise patient safety and the care quality provided. Poor communication can
increase hospital readmission rates and negatively affect patient satisfaction. (Molina-Mula & Gallo-
Estrada, 2020; Ratna, 2019). Ineffective communication in healthcare settings can result in a range
of negative outcomes. Studies have shown that poor communication is a significant factor in medical
errors. Communication failures can manifest as misunderstandings between healthcare providers
and patients, leading to inappropriate treatments or delayed diagnoses. (Ratna, 2019).
Furthermore, it can diminish patient satisfaction. When patients feel that their concerns are not being
heard or understood, they may become disengaged from their treatment plans. The disengagement
can lead to non-adherence to prescribed therapies and an overall decline in health outcomes.
Research indicates that effective communication is associated with higher patient satisfaction scores,
as patients who feel valued and understood are more likely to trust their healthcare providers and
adhere to treatment recommendations. (Umar, et al, 2012). Effective nurse-patient communication
has been directly correlated with improved patient outcomes as they have a better understanding of
their health conditions and treatment plans. High-quality interactions increase patient safety. (Ratna,
2019; Howick et al., 2014).
As important as effective communication, the need for culturally competent healthcare practitioners,
particularly nurses, is crucial to interact with patients from diverse backgrounds. There are many
definitions of cultural competence mentioned by experts. It can be summarized that cultural
competence refers to awareness, knowledge, skills, encounters, desire, sensitivity, and attitudes that
enable healthcare providers to understand and respond to the cultural needs of their patients. This
cultural competence is crucial for delivering high-quality care and ensuring equitable treatment for
patients across health beliefs, religion, age, gender, education, and race. (Sharifi et al., 2019;
Constantinou et al., 2022; Liu et al., 2022).
Effective communication is not merely about exchanging information; it involves understanding the
cultural contexts that shape patients’ beliefs, values, and health behaviors. Research indicates that
cultural competence in nursing can significantly improve patient outcomes by fostering trust and
enhancing patient engagement in their care. (Liu et al., 2022). When nurses are aware of their own
cultural biases and are open to learning about their patients’ cultural backgrounds, they can provide
more personalized and effective care.
Incorporating insights from intercultural communication theories can further enhance
understanding of how cultural differences impact communication styles and expectations. Messages
are interpreted differently based on different cultural backgrounds. High-context communicators
rely heavily on non-verbal cues and the surrounding context. Meanwhile, low-context
communicators prioritize explicit verbal information. Recognizing these differences allows
healthcare providers to tailor their communication strategies to meet the needs of their diverse
patient population.
Culturally competent care not only improves patient satisfaction but also reduces health disparities.

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Patients are more likely to adhere to treatment plans and engage actively in their healthcare when
healthcare providers demonstrate cultural awareness and sensitivity (Cerezo et al., 2014). This
engagement is critical for achieving positive health outcomes, as patients who feel understood and
respected are more likely to trust their healthcare providers.
Moreover, the development of cultural competence among nursing staff is associated with improved
clinical skills and enhanced patient interactions (Molina-Mula & Gallo-Estrada, 2020). Training
programs focused on cultural competence can equip nurses with the necessary tools to navigate
complex cultural dynamics in healthcare settings. Such programs often emphasize the importance of
active listening, empathy, and adaptability in communication.
Thus, the importance of effective communication in healthcare cannot be overstated. It serves as the
foundation for building trust between patients and providers, ensuring accurate diagnoses,
preventing medical errors, and ultimately improving health outcomes. As the healthcare landscape
continues to evolve, prioritizing effective communication strategies will be essential for fostering a
culture of safety and quality care. The current study will reveal the gap in healthcare providers-
patient communication within themes suggested by Candlin and Candlin (2003) which include the
use of interpreters, narratives, risk, nonnative-native interactions, patients-practitioners’
interactions, and critical accounts (e.g. authority and acknowledging patients’ autonomy).

METHOD
This research was conducted in a small-scope context and used semi-structured interviews to collect
data. There were seven healthcare practitioners involved in this study: 2 doctors (an ophthalmologist
and a pediatrician), 2 midwives, and 2 nurses. Five of them are Indonesians and one of them (the
pediatrician) comes from Finland. The subjects have been working in their field for at least a year.
The five Indonesian healthcare practitioners are currently providing health care services in clinics
and hospitals in Java, Indonesia while the Finnish pediatrician shared her stories about what she did
when she was providing a health care service back then in Finland. They were selected randomly
based on their availability for the interviews and accessibility. The description of the participants’
profiles is shown in Table 1.
Table 1. The Health Care Practitioners’ Profile

Practitioners/Country Professional Years of Health Previous Training

Position Care Service
Miss LH/Indonesia ophthalmologist 28 years General Practice (1998-
2009)
Ophthalmology
(2009-present)
Miss LA/Finland pediatrician 10 years Pediatrics
Miss MR /Indonesia midwife 20 years Midwifery
Miss CM/Indonesia internist nurse 3 years Nursing
Mr. E/Indonesia public service 1 year Nursing
Mr. ULS/Indonesia internist nurse 1 year Nursing

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The participants were asked to talk about their stories in health care communication related to
themes suggested by Candlin and Candlin (2003) which include the use of interpreters, narratives,
risk, nonnative-native interactions, patients-practitioners’ interactions, and critical accounts (e.g.
authority and acknowledging patients’ autonomy). The semi-structured interviews lasted for 3-10
minutes. The interview results were analyzed based on six themes developed by Candlin and Candlin
(2003).

FINDINGS AND DISCUSSION

Research findings are identified based on the six themes coded by Candlin and Candlin (2003). The
first theme to be described is the use of interpreters. Followings are narratives, risk, nonnative-native
interactions, patient-practitioners’ interactions, and critical accounts (e.g. authority and
acknowledging patients’ autonomy).
The Use of Interpreters
As believed by Candlin and Candlin (2003), this theme is considered to be the most addressed theme
in medical education which is mostly engaged with the intercultural context. Since Indonesia consists
of many different tribes and cultural communities, there are diverse languages spoken in this
country. So, not limited to English or foreign languages, the health care practitioners admitted that
they also faced difficulties dealing with issues related to local languages. Some of the languages that
the participants dealt with are English, Arabic, Somalian, Thai, Madurese, Ambonese, and Dayak
(Borneo).
There is no interpreter service provided by the clinics or hospitals. So, according to Miss LA, the
hospital usually calls and books an interpreter and asks for his service. Meanwhile, if there is no
attempt made by the hospital to provide an interpreter service, the doctors, midwives, and nurses
use gestures or pictures, such as explained by Miss MR as follows.
“I never used an interpreter service… I used gestures…Midwifery is usually related to birth
control, pregnancy, and such. Therefore, I can use pictures to explain important information to
the patients who cannot speak Bahasa Indonesia or Javanese.”
Another way the practitioners do this if there is no interpreter provided, is by calling a friend who
can speak the patient’s language. Mr. E shared:
“What if the patient cannot speak Bahasa Indonesia? The solution is to call a friend, the patient’s
family, or other patients who can speak that language… But, most of the nurses usually can
communicate verbal or non-verbal language…”
Overall, the participants admitted that they could probably use an interpreter’s service, pictures,
gestures, or talk to the patient’s family who can speak Bahasa Indonesia fluently, or they might ask
for help.

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Based on the results of the interview above related to the use of interpreters, it can be said that in
the Indonesian context, there is more to explore related to intercultural context. Since Indonesia is a
country with a million local languages, probably, an applied linguist can consider exploring the use
of sign language in healthcare communication. Probably, the applied linguist can also involve the role
of the family in helping to solve the language-related issue. If it is related to the ability of the
practitioners to speak English or other foreign languages, the applied linguist can consider looking
at the issue of healthcare professional development, such as the one conducted by Alqurashi (2016).
Healthcare practitioners often encounter significant challenges when navigating language barriers,
particularly in multicultural settings like Indonesia, where numerous local languages are spoken
alongside foreign languages. One primary challenge is the lack of professional interpreter services in
many clinics and hospitals. As noted by Candlin and Candlin (2003), this absence can lead to
healthcare providers relying on informal methods of communication, such as gestures or the use of
family members as interpreters. Such practices can result in misunderstandings that adversely affect
patient care. For instance, incorrect medication administration may occur if a practitioner
misinterprets a patient’s symptoms due to language barriers, leading to potentially harmful
outcomes (Flores, 2006).
Moreover, the reliance on non-professional interpreters can compromise the accuracy of medical
information conveyed. Family members or friends may not possess the necessary medical
vocabulary or understanding of healthcare concepts, which can lead to critical information being lost
or miscommunicated. This scenario is particularly concerning in high-stakes situations where
precise understanding is essential for patient safety.
To address these challenges, technology offers promising solutions that can enhance communication
between healthcare practitioners and patients with limited language proficiency. Telehealth
interpreting services and mobile translation applications have emerged as valuable tools that can
bridge communication gaps in real time. For example, telehealth platforms can connect healthcare
providers with professional interpreters via video or audio calls, allowing for more accurate and
effective communication during consultations (Shigekawa et al., 2018). This approach not only
facilitates better understanding but also ensures that patients receive appropriate care tailored to
their specific needs.
The existence of interpreters, either in-person or via video/telephone, to assist patients is highly
satisfying. Trained interpreters must be provided in healthcare facilities as language barriers have
the potential to make the health services ineffective and inefficient for the patients. It is proven that
the use of interpreters improves clinical interventions, satisfaction, and clinical outcomes (Joseph,
Garruba, & Melder, 2018).
Digital translation apps can further assist practitioners in overcoming language barriers by providing
instant translations of medical terms and phrases. These tools empower healthcare providers to
communicate essential information without relying solely on informal interpreters. However,
practitioners must remain aware of the limitations of these technologies, as automated translations
may not always capture the nuances of medical language or cultural context. Employing multimedia

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tools add value to healthcare services due to their benefits, such as health education and stimulation
for patients, and positive affective effects (Schouten et al., 2020).
In Indonesia’s context, where diverse languages are prevalent, the integration of technology into
healthcare communication strategies could significantly improve patient outcomes. By leveraging
telehealth interpreting services and translation apps, healthcare practitioners can enhance their
ability to provide culturally competent care, ultimately fostering trust and improving patient
satisfaction.
Narratives
Narratives, according to Candlin and Candlin (2003), are the main themes discussed related to the
sociology of health. What is questionable is how an applied linguist can access the information related
to the patient’s illness. One of the participants admitted that all medical information related to the
patients and their illnesses was written in a confidential medical record. As stated by Miss LA:
“Every doctor in the hospital can access the information about the (patient) visit…It’s open to
the hospital… but it’s not open to the public…only for the doctors who are treating the patients.”
This finding indicates that the only way to obtain information related to the patient’s narrative illness
is through the patient himself because probably, the hospital will keep it confidential unless the
patient permits them to reveal it.
Patient narratives play a crucial role in understanding health outcomes and enhancing the quality of
care provided. By incorporating patients’ stories into their treatment plans, healthcare practitioners
can gain valuable insights into the patients’ experiences, beliefs, and values. This patient-centered
approach fosters a more holistic view of healthcare, allowing providers to tailor interventions that
resonate with individual patients. Research in narrative medicine emphasizes the importance of
listening to patients’ narratives as a means to improve treatment adherence and overall satisfaction
(Charon, 2006). When patients feel that their voices are heard and their experiences validated, they
are more likely to engage actively in their care, leading to better health outcomes.
Moreover, recognizing the significance of patient narratives can help healthcare providers identify
barriers to adherence. For instance, a patient may have cultural beliefs that influence their
willingness to accept certain treatments. By understanding these narratives. practitioners can work
collaboratively with patients to address concerns and develop mutually agreeable treatment plans
(Greenhalgh, 1999). This collaborative approach not only enhances adherence but also empowers
patients by involving them in their healthcare decisions.
Risk
Not much information can be obtained under this theme. However, almost all the participants said
that when dealing with a certain policy regarding the risk that the patient might face due to
medication or specific surgical procedures, they would use the following techniques.
First, the patients will be told about their immediate conditions. After that, they would be told about
the side effects of the medication so that they could anticipate it. If a certain surgical procedure had

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to be done, they would be allowed to decide whether they would do it or not. Miss LH, an
ophthalmologist said:
“All the decisions are made by the patients. Doctors only tell, but back again, the decisions are
on the patients.”
One interesting finding here is that the Finnish doctor said that nurses in Finland were allowed to
initiate ideas to the doctors related to risks that the patients might face, such as medication that might
cause nausea. The nurses could comment on drugs suggested by the doctors if the drugs do not suit
the patients’ conditions. This finding shows that risk can also be explored by nurses, not only doctors
as suggested by Candlin and Candlin (2003).
Past studies suggest that effective communication about potential risks associated with medications
and surgical procedures is essential for patient safety and informed decision-making. Syyrilä et al.
(2021) highlight that healthcare professionals’ perceptions of medication communication
significantly influence patient safety, emphasizing the need for clear and comprehensive discussions
about medication risks. Regarding surgical procedures, shared decision-making (SDM) has been
identified as a critical component in patient care. Barnett and Swart (2021) discuss how SDM
involves clinicians and patients collaborating to select the best treatment options, underscoring its
importance in surgical contexts.
These study findings suggest that both nurses and doctors play pivotal roles in communicating risks
to patients, ensuring that patients are well-informed and actively involved in decisions regarding
their treatment options.
Nonnative-native Interactions and Patients-Practitioners Interactions: Previous Training
These two themes are discussed under one subheading since the findings only provide general
explanations related to patients-practitioners interactions which also include nonnative-native
interactions. Related to the patient-practitioner interactions, only three of the participants (Miss CM,
Mr. E, and Mr. ULS) mentioned the term therapeutic communication. Meanwhile, the other three who
have been practicing health care service for more than 10 years are not quite informed about this.
For example, Mr. E with one year of experience as a nurse said:
“In every health care institution, we (students) are always trained in how to communicate with
the patients. It is called therapeutic communication.”
Mr. ULS with one year of experience as an internist nurse also added:
“We use therapeutic communication as a technique to talk to the patients. We have learned this
technique at the nursing school. For example, “You should eat a lot, Mam?” or “Are you feeling
better? Do you have any complaints?”
Meanwhile, Miss LA, who has been practicing as a pediatrician for 10 years did not mention
therapeutic communication at all. When she asked about how to talk to the patients (Have you ever
learned how to talk to the patients at the medical school?), she said:
“Yes, we have. How to talk with the patients, but just a tiny one…but only how to generally talk
with the patients.”

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The word tiny in the interview excerpt indicates that the doctor did get training on how to talk to the
patients but not in detail.
They, on the other hand, learned that from their lecturer indirectly, such as admitted by Miss LH, an
ophthalmologist who has been working as a doctor for 28 years:
“We did not learn how to communicate with the patients in particular. However, we indirectly
learned our lecturers’ behaviors as doctors. But the thing is that they always warn us not to
give a lot of sympathy to the patients…”
Also, Miss MR, a midwife who has been helping people with birth control and pregnancy for 20 years
said:
“I got the training around eight years ago at school. But other information related to that was
obtained from reading and practicing.”
These research findings suggest that therapeutic communication has been taught to healthcare
practitioners for the last decade. Doctors, midwives, and nurses born before that had to struggle to
learn how to communicate with the patients. Related to applied linguistics research, it is
recommended that if the applied linguist wants to explore more on therapeutic communication in
particular, they need to involve doctors, nurses, midwives, or other health care practitioners who
have been serving for the last ten years. Otherwise, what they might get is only the answer “We learn
by ourselves”.
Research indicates that therapeutic communication has become a fundamental component of
healthcare education over the past decade. A study by Mersha et al. (2023) highlights that effective
nurse-patient communication can significantly improve clinical outcomes, underscoring the
importance of training in this area. Similarly, De Sousa Mata et al. (2021) discuss how training in
communication skills enhances the performance and self-efficacy of health professionals,
emphasizing the necessity of such training for effective patient interactions.
These findings suggest that while therapeutic communication is now a standard part of healthcare
training, practitioners with over a decade of experience may not have received formal education in
this area. Consequently, applied linguists aiming to explore therapeutic communication should
consider involving healthcare practitioners with less than ten years of experience to gain insights
into their training and practices.
Critical Accounts
Research findings related to critical accounts in this context are mainly associated with patients’
satisfaction. All the participants admitted that they rarely heard patients’ satisfaction delivered
orally. Nevertheless, there are various ways to find out whether the patients are satisfied with their
service. The first one is through the feedback box which is provided by the hospitals or clinics. Miss
LA said:
“Mostly, if the patients are satisfied, then they don’t give any feedback…but usually the
feedback is written in the feedback box”
“Thank you” is the common phrase mentioned by patients when they feel satisfied. However, the

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gesture also indicates satisfaction. Mr. E, a one-year experience nurse, admitted:

“The expression of satisfaction that I got personally is when the patient smiles every time I
visit. People who are sick find it difficult to smile, but when they smile when they get treatment,
it means they put their trust in the nurse, they hope for a better condition, and of course, feel
satisfied with the service.”
These results of the study once more strengthen the idea of exploring healthcare communication not
only in the form of spoken language but also in written language such as email and gesture. Research
indicates that patient satisfaction is a multifaceted concept, encompassing verbal feedback, written
comments, and non-verbal cues such as gestures. Radmore, et al. (2020) emphasize the importance
of diverse feedback mechanisms in assessing patient satisfaction, noting that both verbal and non-
verbal expressions are integral to understanding patient experiences. Additionally, a study by
Sharkiya (2023) highlights that quality communication significantly influences patient-centered
outcomes, suggesting that effective communication encompasses various forms, including verbal,
written, and non-verbal interactions. These research findings underscore the necessity for
healthcare providers to consider multiple forms of communication—spoken, written, and non-
verbal—to accurately assess and enhance patient satisfaction.

CONCLUSION
Healthcare can be one of the field interests of applied linguistics study. This field provides a plethora
of ways to explore the use of language in communication since a great number of people are involved
in it, such as numerous healthcare practitioners including doctors, nurses, midwives, and many
others. Even doctors are specialized in many professional areas. Not to mention, problems that may
arise in a communication context between patients-practitioners.
Candlin and Candlin (2003) in their article entitled, “Health Care Communication: A Problematic Site
for Applied Linguistics Research” attempted to help both applied linguists and healthcare
practitioners solve their real-world problems by providing six themes that they thought best for
applied linguistics study. By referring to these themes: the use of interpreters, narratives, risk,
nonnative-native interactions, patients-practitioners’ interactions, and critical accounts (e.g.
authority and acknowledging patients’ autonomy), the present study tried to investigate what might
be missing from Candlin and Candlin’s piece of writing.
The present research results reported in this article have proven that oral communication is not the
only medium through which applied linguists can reveal problems and solutions in healthcare
communication. Added to it are sign language and written communication such as e-mail, feedback
box, and many others. Related to the site suggested by Candlin and Candlin, the research findings are
positive about it and do not contradict the idea. However, other people that should be considered as
well in this context are the patient’s family and the other patients who are in touch with the patients.
To answer the question: is nursing a perfect site for applied linguistics study more comprehensive
studies are needed to be conducted. Candlin and Candlin (2003) have provided a basis for any applied
linguists who are interested in healthcare communication. The six themes suggested are very

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practical. The present study only delineates small parts in this context. Described under the six
themes, however, the findings can contribute to what Candlin and Candlin have suggested in their
previous book chapter: healthcare communication should be explored in nursing.

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